RISK FACTORS : ASSOCIATED CONNECTIVE TISSUE DISORDERS LIKE SYSTEMIC SCLERODERMA, SLE, DERMATOMYOSITIS, POLYMYOSITIS, RHEUMATOID ARTHRITIS
Medical Care:
" General measures: These include education, warming of local body part, and cessation of vasoconstricting agents such as nicotine.
" Primary Raynaud
o Use calcium channel blockers, especially those that cause vasodilation. The most commonly used drug is nifedipine. Use the lowest dose of a long-acting preparation and titrate up as tolerated. If adverse effects occur, decrease dosage or use another agent such as nicardipine, amlodipine, or diltiazem.
o Angiotensin-converting enzyme inhibitors and intravenous prostaglandins have been advocated, and clinical trials have indicated some benefit. The selective serotonin uptake inhibitor fluoxetine has also been shown effective in at least one study.
o Therapy with antiplatelet agents has been tried but has not been proven effective, and anticoagulation is not indicated. The angiotensin-receptor antagonist losartan at 50 mg/d has been found effective in patients with primary Raynaud and scleroderma.
" Secondary Raynaud
o Therapy must be tailored to the underlying disorder.
o If associated with occupational or toxic exposure, the patient should avoid the inciting environment.
o Patients with hyperviscosity syndromes and cryoglobulinemia improve with treatments that decrease the viscosity and improve the rheologic properties of their blood (eg, plasmapheresis).
o Unfortunately, patients with autoimmune disorders and associated Raynaud phenomenon do not usually respond well to therapy.
o Infections such as hepatitis B, hepatitis C, and Mycoplasma infections need to be addressed.
o In older patients with new-onset Raynaud and no obvious underlying cause, malignancy must be considered.
Surgical Care:
" Cervical sympathectomy still is considered controversial and may offer only temporary relief.
" Digital sympathectomy has been gaining support for patients with severe or tissue-threatening disease. This may be used in patients with either primary or secondary disease, but it is more commonly necessary with the secondary forms.
Diet: Fish oils containing omega-3-fatty acids may be beneficial to some patients with primary Raynaud.
Activity:
" Nondrug therapy may be all that is required for mild cases of primary Raynaud phenomenon. Therapies can include the following:
o Biofeedback and relaxation
o Avoiding inciting environmental factors such as direct contact with frozen foods or cold drinks
o Insulation against cold and local warming, including electric and chemical warming devices
o Removing any drugs from the medical regimen that may provoke vasospasm
o Avoiding smoking
" With time, most patients learn to incorporate these therapies on their own.